This invention relates to surgical apparatus and methods in general, and more particularly to apparatus and methods for approximating and closing the walls of a hole or puncture in a physiological shell structure.
Many surgical procedures require the insertion of instruments or catheters into vessels or organs through a small insertion placed in the wall of the structure (e.g., arteries and veins). Once the procedure is completed, these holes often need to be closed with sutures. Unfortunately, when the hole is difficult to see or physically reach, conventional needles and sutures are not easily utilized since this requires finding the edges of the hole, passing sutures through the edges, and then tying secure knots.
As a result, one object of the present invention is to provide means for locating and suturing remote tissue edges.
Another object of the present invention is to provide for the delivery of a device to the surgical site that locates itself to the tissue edges so that the device can deliver needleless sutures (e.g., needleless wire sutures) for tissue closure.
And another object of the present invention is to provide for needleless suturing of tissue so as to eliminate the need to shuttle a needle in and out of the tissue where there is little room to do so.
Still another object of the present invention is to provide means for producing a knot (e.g., twists or turns) in the wire suture that does not require the cumbersome manual manipulations of the surgeon.
Yet another object of the present invention is to provide suturing means whereby both the suture placement and the knot formation are somewhat automated, yet the surgeon still has tactile feedback in these operations so that control is not lost.
And another object of the present invention is to provide a novel method for approximating tissue.
These and other objects are addressed by the present invention which, in one preferred form, comprises a pair of components that manipulate wire suture so as to close holes in physiological shell structures. The first component, sometimes hereinafter referred to as a suture introducer, locates the edges of the holes and passes wire suture through them. The second component, sometimes hereinafter referred to as a suture tensioner, gathers the free ends of the wire suture and twists them together, which in turn closes the holes. After the wire suture has been twisted sufficiently to effect closure, the excess wire is trimmed away. The apparatus can deploy more than one wire suture at a time if desired. Using self-locating features and tactile feedback, the apparatus is particularly well adapted to access remote surgical sites.